26-Year-Old Male with Right Scrotal Pain and Swelling

CASE SCENARIO We are pleased to introduce a new feature to Reviews in Urology: the “Case Scenario" section. In each issue, a brief case report will be presented, followed by multiple management options. After reviewing the case, readers will make their selection regarding case management and fax or e-mail their response to MedReviews. The distribution of responses will be summarized in the next issue of the journal, along with a discussion by one of our editors of the various management options and the editor’s choice as to the best of these. CASE SCENARIO: 26-Year-Old Male with Right Scrotal Pain and Swelling Isla Garraway, MD, Joseph Liao, MD, Jacob Rajfer, MD UCLA School of Medicine and Division of Urology, Harbor-UCLA Medical Center, Los Angeles, CA [Rev Urol. 2002;4(1):43] © 2002 MedReviews, LLC CASE REPORT 26-year-old male presented to the emergency room with acute onset of right-sided scrotal pain. The pain awoke him from sleep approximately 2 hours prior to presentation and began in the right lower quadrant, then quickly localized to the scrotum. With the onset of pain he noted swelling of the right testicle. There was no fever, chills, nausea, or vomiting. Upon examina- A tion, the abdomen was benign. The right scrotum appeared mildly enlarged. Palpation revealed a thickened spermatic cord and a mildly enlarged but tender testicle. The epididymis was palpated in the anterolateral part of the scrotum. The cremasteric reflex could not be demonstrated on either side. Initial laboratory tests including urinalysis were normal except for mild leukocytosis. MANAGEMENT OPTIONS Select one: ❑ 1. Obtain scrotal ultrasound ❑ 2. Go directly to operating room for scrotal exploration ❑ 3. Urine culture and antibiotics and re-evaluation in 3 days ❑ 4. Testis tumor markers and CT scan of abdomen ✁ Fax your selection to MedReviews: (212) 971-4047, or send an e-mail message with your selection to dgern@medreviews.com. Selections will be tabulated and presented in the next issue of Reviews in Urology. VOL. 4 NO. 1 2002 REVIEWS IN UROLOGY 43